Bates method
The Bates method is an alternative therapy aimed at improving eyesight. Eye-care physician William Horatio Bates, M.D., (1860–1931) attributed nearly all sight problems to habitual strain of the eyes, and felt that glasses were harmful and never necessary. Bates self-published a book as well as a magazine (and earlier collaborated with Bernarr MacFadden on a correspondence course) detailing his approach to helping people relax such "strain", and thus, he claimed, improve their sight. His techniques centered around visualization and movement. He placed particular emphasis on imagining black letters and marks, and the movement of such. He also felt that exposing the eyes to sunlight would help alleviate the "strain". The famed British writer Aldous Huxley, whose corneas had been scarred from the age of sixteen, learned the Bates method from Bates student Margaret Darst Corbett beginning in 1939, and in 1942 wrote his own book about the method. He reported that his eyesight had improved significantly, but admitted that it remained far from normal. Whether his vision had truly improved was frequently questioned. Despite continued anecdotal reports of successful results, Bates' techniques have not been shown to objectively improve eyesight, and his main physiological proposition – that the eyeball changes shape to maintain focus – has consistently been contradicted by observation. In 1952, optometry professor Elwin Marg wrote of Bates, “Most of his claims and almost all of his theories have been considered false by practically all visual scientists.” Marg concluded that the Bates method owed its popularity largely to "flashes of clear vision" experienced by many who followed it. Such occurrences have since been determined to most likely be a contact lens-like effect of moisture on the eye. Critics of the Bates method not only deny its efficacy, but go on to cite potential negative consequences for those who attempt to follow it, namely that they might overexpose their eyes to sunlight, put themselves and others at risk by not wearing their corrective lenses while driving, or neglect conventional eye care, possibly allowing serious conditions to develop. Underlying concepts Accommodation Accommodation is the process by which the eye increases optical power to maintain focus on the retina while shifting its gaze to a closer point. The long-standing medical consensus is that this is accomplished by action of the ciliary muscle, a muscle within the eye, which adjusts the curvature of the eye's crystalline lens. This explanation is based on observation, photographs, and laboratory test results. Bates, however, reaffirmed a different explanation of accommodation which had already been generally disregarded by the medical community of his time. This model had the [[extraocular muscles|muscles surrounding the eyeball]] controlling its focus. In addition to their known function of turning the eye, Bates maintained, they also affect its shape, elongating the eyeball to focus at the near-point or shortening it to focus at a distance. He claimed to have support for this theory from the results of his own experiments, which have not been independently reproduced. Commenting on this hypothesis in an interview with WebMD, ophthalmologist Richard E. Bensinger stated "When we put drops in the eye to dilate the pupil, they paralyze the focusing muscles. The evidence of the anatomical fallacy is that you can't focus, but your eye can move up and down, left and right. The notion that external muscles affect focusing is totally wrong." Science author John Grant writes that many animals, such as fishes, accommodate in such a manner, "it's just that humans aren't one of those animals." Laboratory tests have shown that the eyeball is far too rigid to spontaneously change shape to a degree which would be necessary to accomplish what Bates described. Exceedingly small changes in axial length of the eyeball (18.6-19.2 micrometres) are caused by the action of the ciliary muscle during accommodation. However, these changes are far too small to account for the necessary changes in focus, producing changes of only -0.036 dioptres. Causes of sight problems Medical professionals characterize refractive errors such as nearsightedness, farsightedness, astigmatism, and presbyopia (the age-related blurring of near-point vision) as "static, anatomic conditions" caused by "structural defect of the eyeball", which as such cannot be altered by relaxation or exercise. Bates, on the other hand, believed that these conditions are caused by tension of the muscles surrounding the eyeball, which he believed prevents the eyeball from sufficiently changing shape (per his explanation of accommodation) when gaze is shifted nearer or farther. Bates characterized this supposed muscular tension as the consequence of a "mental strain" to see, the relief of which he claimed would instantly improve sight. He also linked disturbances in the circulation of blood, which he said is "very largely influenced by thought", not only to refractive errors but also to double vision, crossed-eye, lazy eye, and to more serious eye conditions such as cataracts and glaucoma. His therapies were based on these assumptions. Bates felt that corrective lenses, which he characterized as "eye crutches", are an impediment to curing poor vision. In his view, "strain" would increase as the eyes adjust to the correction in front of them. He thus recommended that glasses be discarded by anyone applying his method. Treatments In his writings, Bates discussed several techniques which he claimed helped patients to improve their sight. He wrote that "The ways in which people strain to see are infinite, and the methods used to relieve the strain must be almost equally varied", emphasizing that no single approach would work for everyone. His techniques were all designed to help dissociate this "strain" from seeing and thereby achieve "central fixation", or seeing what is in the central point of vision without staring. He asserted that "all errors of refraction and all functional disturbances of the eye disappear when it sees by central fixation" and that other conditions were often relieved as well. Palming Bates suggested closing the eyes for minutes at a time to help bring about relaxation. He asserted that the relaxation could be deepened in most cases by "palming", or covering the closed eyes with the palms of the hands, without putting pressure on the eyeballs. If the covered eyes did not strain, he said, they would see "a field so black that it is impossible to remember, imagine, or see anything blacker", since light was excluded by the palms. However, he reported that some of his patients experienced "illusions of lights and colors" sometimes amounting to "kaleidoscopic appearances" as they "palmed", occurrences which he attributed to his ubiquitous "strain" and which he claimed disappeared when one truly relaxed. This phenomenon, however, was almost certainly caused by Eigengrau or "dark light". In fact, even in conditions of perfect darkness, as inside a cave, neurons at every level of the visual system produce random background activity that is interpreted by the brain as patterns of light and color. Visualization Bates placed importance on mental images, as he felt relaxation was the key to clarity of imagination as well as of actual sight. He claimed that one's poise could be gauged by the visual memory of black; that the darker it appeared in the mind, and the smaller the area of black which could be imagined, the more relaxed one was at the moment. He recommended that patients think of the top letter from an eye chart and then visualize progressively smaller black letters, and eventually a period or comma. But he emphasized his view that the clear visual memory of black "cannot be attained by any sort of effort", stating that "the memory is not the cause of the relaxation, but must be preceded by it", and cautioned against "concentrating" on black, as he regarded an attempt to "think of one thing only" as a strain. While Bates preferred to have patients imagine something black, he also reported that some found objects of other colors easiest to visualize, and thus were benefited most by remembering those, because, he asserted, "the memory can never be perfect unless it is easy". Skeptics reason that the only benefit to eyesight gained from such techniques is itself imagined, and point out that familiar objects, including letters on an eye chart, can be recognized even when they appear less than clear. Movement Bates felt that the manner of eye movement affected the sight. He suggested "shifting", or moving the eyes back and forth to get an illusion of objects "swinging" in the opposite direction. He believed that the smaller the area over which the "swing" was experienced, the greater was the benefit to sight. He also indicated that it was usually helpful to close the eyes and imagine something "swinging". By alternating actual and mental shifting over an image, Bates wrote, many patients were quickly able to shorten the "shift" to a point where they could "conceive and swing a letter the size of a period in a newspaper." One who mastered this would attain the "universal swing", Bates believed. In his Better Eyesight magazine, Bates set forth several techniques designed to help realize and then shorten the "swing". One such method was the "long swing", which consisted of standing with the feet a foot apart, slowly turning the body alternately from left to right and right to left while raising the opposite heel off the ground, allowing the head and eyes to move with the body, without paying attention to the apparent movement of stationary objects. Bates said that at first, the long swing was the "optimum swing" due to being wide, but indicated that it could be shortened down to "the normal swing of the normal eye." Perhaps finding Bates' concepts of "shifting" and "swinging" too complicated, some proponents of vision improvement, such as Bernarr Macfadden, suggested simply moving the eyes up and down, from side to side, and shifting one's gaze between a near-point and a far-point. Sunning being used to focus sunlight on someone's eye, from Perfect Sight Without Glasses.]] Bates believed that the eyes were benefited by exposure to sunlight. He stated that "persons with normal sight can look directly at the sun, or at the strongest artificial light, without injury or discomfort", and gave several examples of patients' vision purportedly improving after having done so—this is at variance with the well-known risk of eye damage which can result from direct sunlight observation. Photographs in Chapter 17 of Bates' Perfect Sight Without Glasses portray multiple individuals allegedly sungazing with "no sign of discomfort", and one features somebody "Focussing the Rays of the Sun Upon the Eye of a Patient by Means of a Burning glass." Bates cautioned that, just as one should not attempt to run a marathon without training, one should not immediately look directly at the sun, but he suggested that it could be worked up to. He acknowledged that looking at the sun could have ill effects, but characterized them as being "always temporary" and in fact the effects of strain in response to sunlight. He wrote that he had cured people who believed that the sun had caused them permanent eye damage. In his magazine, Bates later suggested exposing only the white part of the eyeball to direct sunlight, and only for seconds at a time, after allowing the sun to shine on closed eyelids for a longer period. Ultimately, posthumous publications of Bates' book omitted mention of the supposed benefits from direct sunlight shining on open eyes. Results The purported benefits of Bates' techniques are generally anecdotal, and their supposed effectiveness in improving eyesight has not been substantiated by medical research. Several of Bates' techniques, including "sunning", short- and long- "swinging", and "palming", were combined with healthy changes to diet and exercise in a 1983 randomized controlled trial of myopic children in India. After 6 months, the experimental groups "did not show any statistically significant difference in refractive status", but the children in the treatment group "subjectively ... felt relieved of eye strain and other symptoms." It has been argued, such as by philosopher Frank J. Leavitt, that the method which Bates described would be difficult to test scientifically due to his emphasis on relaxation and visualization. Leavitt asked "How can we tell whether someone has relaxed or imagined something, or just thinks that he or she has imagined it?" In regards to the possibility of a placebo trial, Leavitt commented "I cannot conceive of how we could put someone in a situation where he thinks he has imagined something while we know that he has not." After Bates After Bates died in 1931, his methods of treatment were continued by his widow Emily and other associates, some of who incorporated exercises and dietary recommendations. Most subsequent proponents did not stand by Bates' explanation of how the eye focuses mechanically, but nonetheless maintained that relieving a habitual "strain" was the key to improving sight. Margaret Darst Corbett Margaret Darst Corbett first met Dr. Bates when she consulted him about her husband’s eyesight. She became his pupil, and eventually taught his method at her School of Eye Education in Los Angeles. She was of the stated belief that "the optic nerve is really part of the brain, and vision is nine-tenths mental and one-tenth only physical." In late 1940, Corbett and her assistant were charged with violations of the Medical Practice Act of California for treating eyes without a licence. At the trial, many of her students testified on her behalf, describing in detail how she had enabled them to discard their glasses. One witness testified that he had been almost blind from cataracts, but that, after working with Corbett, his vision had improved to such an extent that for the first time he could read for eight hours at a stretch without glasses. Corbett explained in court that she was practicing neither optometry nor ophthalmology and represented herself not as a doctor but only as an “instructor of eye training”. Describing her method she said "We turn vision on by teaching the eyes to shift. We want the sense of motion to relieve staring, to end the fixed look. We use light to relax the eyes and to accustom them to the sun." The trial attracted widespread interest, as did the “not guilty” verdict. The case spurred a bill in the Californian State Legislature which would have then made such vision education illegal without an optometric or medical licence. After a lively campaign in the media, the bill was rejected. The case of Huxley Perhaps the most famous proponent of the Bates method was the British writer Aldous Huxley. At the age of sixteen Huxley had an attack of keratitis, which left him with one eye just capable of light perception and the other with an unaided Snellen fraction of 10/200. This near-blindness was mainly due to opacities in both corneas, complicated by hyperopia and astigmatism. He was able to read only if he dilated his better pupil with atropine and used glasses. In 1939, at the age of 45 and with eyesight which continued to deteriorate, he happened to hear of the Bates method and sought the help of Margaret Corbett, who gave him regular lessons. Three years later he wrote The Art of Seeing, in which he related: "Within a couple of months I was reading without spectacles and, what was better still, without strain and fatigue... At the present time, my vision, though very far from normal, is about twice as good as it used to be when I wore spectacles". His case attracted wide publicity as well as skepticism. Ophthalmologist Walter B. Lancaster, for example, suggested in 1944 that Huxley had simply "learned how to use what he has to better advantage" by training the "cerebral part of seeing", rather than actually improving the "primary retinal sensation". In 1952, ten years after writing The Art of Seeing, Huxley spoke at a Hollywood banquet, wearing no glasses and, according to Bennett Cerf, apparently reading his paper from the lectern without difficulty. In Cerf's words: Then suddenly he faltered—and the disturbing truth became obvious. He wasn't reading his address at all. He had learned it by heart. To refresh his memory he brought the paper closer and closer to his eyes. When it was only an inch or so away he still couldn't read it, and had to fish for a magnifying glass in his pocket to make the typing visible to him. It was an agonizing moment. In response to this, Huxley pointed out that he had "never claimed to be able to read except under very good conditions", and explained that he often did "use magnifying glasses where conditions of light are bad", underscoring that he had not regained anything close to normal vision, and in fact never claimed that he had. Modern variants "Natural vision correction" continues to be marketed by practitioners offering individual instruction, many of who have no medical or optometric credentials. Most base their approach in the Bates method, though some also integrate vision therapy techniques. There are also many self-help books and programs aimed at improving eyesight naturally by various means. The heavily advertised "See Clearly Method" (of which sales were halted by a court order in November 2006, in response to what were found to be dishonest marketing practices) included "palming" and "light therapy", both adapted from Bates. The creators of the program, however, emphasized that they did not endorse Bates' approach overall. In his 1992 book The Bates Method, A Complete Guide to Improving Eyesight—Naturally, "Bates method teacher" Peter Mansfield was very critical of eye care professionals for prescribing glasses. He recommended most of Bates' techniques to improve vision, but omitted sun-gazing. The book included accounts of twelve instances of eyesight improving, but did not report any measurements of refractive error. Claimed success As evidence for the effectiveness of the Bates method, proponents point to the many accounts of people allegedly having improved their eyesight by applying it. While these anecdotes may be told and passed on in good faith, several potential explanations exist for the phenomena reported other than a genuine reversal of a refractive error due to the techniques practiced: *Some cases of nearsightedness are recognized as due to a transient spasm of the ciliary muscle, rather than a misshapen eyeball. These are classed as pseudomyopia, of which spontaneous reversal may account for some reports of improvement. *Research has confirmed that when nearsighted subjects remove their corrective lenses, over time there is a limited improvement (termed "blur adaptation") in their unaided visual resolution, even though autorefraction indicates no corresponding change in refractive error. This is believed to occur due to adjustments made in the visual system. One who has been practicing Bates' techniques and notices such improvement may not realize that simply leaving the glasses off would have had the same effect, which may be especially pronounced if the prescription was too strong to begin with. *Visual acuity is affected by the size of the pupil. When it constricts (such as in response to an increase in light), the quality of focus will improve significantly, at the cost of a reduced ability to see in dim light. *Some eye defects may naturally change for the better with age or in cycles (ophthalmologist Stewart Duke-Elder suggested that this is what happened with Aldous Huxley. ) As well, a cataract when first setting in sometimes results in much improved eyesight for a short time. One who happens to have been practicing the Bates method will likely credit it for any such improvements, though they are unrelated. *Some studies have suggested that a learned ability to interpret blurred images may account for perceived improvements in eyesight. "Flashes of clear vision" Bates method enthusiasts often report experiencing "flashes" of clear vision, in which eyesight momentarily becomes much sharper, but then reverts back to its previous state. Such flashes are not the result of squinting, and can occur in one eye at a time or in both eyes at once. Observation has suggested that both the quality and duration of such flashes can be increased with practice, with some subjects holding a substantial improvement for several minutes. Tests of such subjects have found that the temporary improvement in visual acuity is real, but per retinoscopy is not due to any change in refractive error. A 1982 study concluded that such occurrences are best explained as a contact lens-like effect of moisture on the eye, based on increased tear action exhibited by 15 out of 17 subjects who experienced such improvement. General research In 2004 the American Academy of Ophthalmology (AAO) published a review of various research regarding "visual training", which consisted of "eye exercises, muscle relaxation techniques, biofeedback, eye patches, or eye massages", "alone or in combinations". No evidence was found that such techniques could objectively benefit eyesight, though some studies noted changes, both positive and negative, in the visual acuity of nearsighted subjects as measured by a Snellen chart. In some cases noted improvements were maintained at subsequent follow-ups. However, these results were not seen as actual reversals of nearsightedness, and were attributed instead to factors such as "improvements in interpreting blurred images, changes in mood or motivation, creation of an artificial contact lens by tear film changes, or a pinhole effect from miosis of the pupil." In 2005 the Ophthalmology Department of New Zealand's Christchurch Hospital published a review of forty-three studies regarding the use of eye exercises. They found that "As yet there is no clear scientific evidence published in the mainstream literature supporting the use of eye exercises" to improve visual acuity, and concluded that "their use therefore remains controversial." The techniques which have been formally tested are not necessarily the same as those taught by "natural vision educators", who argue that they lack the funds to carry out formal, controlled tests of their methods. General criticisms Dead-end A frequent criticism of the Bates method is that it has remained relatively obscure, which is seen as proof that it is not truly effective. Writer Alan M. MacRobert concluded in a 1979 article that the "most telling argument against the Bates system" and other alternative therapies was that they "bore no fruit". In regards to the Bates method, he reasoned that "If palming, shifting, and swinging could really cure poor eyesight, glasses would be as obsolete by now as horse-drawn carriages." Others, including philosopher Frank J. Leavitt, have argued that due to Bates' emphasis on relaxation and visualization, application of his principles would depend heavily on each individual, as with martial arts and yoga, and that the Bates method is therefore not discredited simply by its failure to become mainstream. Corrective lenses and safety Discarding one's corrective lenses, as Bates recommended, or wearing lenses weaker than one's prescribed correction, as some Bates method advocates suggest, poses a potential safety hazard in certain situations, especially when one is operating a motor vehicle. James Randi related that his father, shortly after discarding glasses on the advice of Bates' book, wrecked his car. Most teachers of the Bates method caution that when driving, one should wear the correction legally required. Avoidance of conventional treatment One of the greatest potential dangers of faith in the Bates method is that a believer may be disinclined to seek medical advice regarding what could be a sight-threatening condition requiring prompt treatment, such as glaucoma. Also, children with vision problems may require early attention by a professional in order to successfully prevent lazy eye, and parents who subscribe to Bates' ideas may delay seeking conventional care until it is too late. It may further be necessary for a child at risk of developing lazy eye to wear the proper correction. See also * Eye examination * Matthew Luckiesh * Behavioral optometry * Iridology * Pinhole glasses References External links * Published medical articles written by Bates from 1886 to 1923. * Bates' first published article about his method of treating eyesight, American Journal of Ophthalmology, 1891, pp. 181–183. * Strengthening the Eyes—A New Course in Scientific Eye Training in 28 Lessons, by Bernarr MacFadden and William H. Bates, Physical Culture Pub. Co., 1918. * Gale Encyclopedia of Alternative Medicine–Bates Method entry by Lisa Frick. * Coverage of individual cases * * * * Seeing Space: Undergoing Brain Re-Programming to Reduce Myopia, by Antonia Orfield, O.D. Category:Manipulative therapy Category:Ophthalmology Category:Optometry